Plaintiffs claim the rule will undermine reproductive healthcare access and embolden clinicians to discriminate against LGBTQ patients and others.
Facing multiple legal challenges over an effort to bolster healthcare workers' rights to abstain from work-related tasks that violate their conscience or religious views, the Trump administration agreed late last week to delay implementation of the policy at least four months.
The rule, which Health and Human Services (HHS) finalized two months ago, had been set to take effect July 22. But HHS attorneys agreed in a filing Friday to delay the effective date until November 22, for the sake of efficiency, while the parties in a lawsuit brought by the city and county of San Francisco dispute the merits of the case.
San Francisco City Attorney Dennis J. Herrera, a Democrat, argues that the new final rule would require cities like San Francisco to put healthcare staffers' personal or religious beliefs ahead of patients' health and safety. The rule would apply not only to clinicians who object to the actual provision of healthcare services but also to workers whose duties are tangential to the provision of care, such as receptionists, Herrera's office said in a statement lauding the HHS-approved delay as a victory.
"We have won this battle—and it was an important one—but the fight is not over," Herrera said in the statement accusing the Trump administration of "trying to systematically limit access to critical care for women, the LGBTQ community, and other vulnerable populations."
"We're not going to let that happen. We will continue to stand up for what's right," he added. "Hospitals are no place to put personal beliefs above patient care. Refusing treatment to vulnerable patients should not leave anyone with a clear conscience."
San Francisco's lawsuit was filed on the same day that the HHS Office for Civil Rights (OCR) announced the final rule, but various other organizations have since filed similar suits, including one brought by the state of New York.
The controversial policy was proposed more than a year ago after HHS OCR launched its Conscience and Religious Freedom Division to ramp up enforcement of existing legal protections. While critics have warned the policy could harm healthcare access for LGBTQ patients, some religious groups have praised the policy as buttressing more than two dozen statutory provisions that they say went underenforced under former President Barack Obama's eight-year administration.
Supporters of the rule say it appropriately affirms physicians' right to refrain from healthcare services they see as contrary to their ethical obligations. But that's different from situations in which a physician might decline to care for a particular class of people, said Farr A. Curlin, MD, a professor of medicine and medical humanities at the Duke University School of Medicine and co-director of the Theology, Medicine and Culture Initiative at Duke Divinity School.
"They are not refusing to care for gays or transgender patients or anyone else who is sick and in need of healing," Curlin told HealthLeaders via email in May. "Rather, they are objecting to practices that they believe contradict their profession to heal only, and never to harm."
Safyer, who was appointed to the position in 2008 after serving as Montefiore's senior vice president and chief medical officer, told colleagues in a letter that he will continue to serve i nthe role until his successor is appointed.
"It has been an honor to dedicate my life's work to an organization that has given so much to so many," Safyer wrote in the letter, which was released to HealthLeaders. "My entire professional life has been at Montefiore and Einstein. Much has changed over the years, but there has been one constant throughout—from my medical school training at Einstein, followed by residency training at Montefiore, throughout progressive leadership positions, and now as President and CEO—I have worked with the very best physicians; scientists; nurses; social workers; managers; and care, support and facilities staff at every level of this organization."
"To my leadership team, and to all of you, who make us who we are: thank you," Safyer wrote.
"Since I became CEO, healthcare has undergone enormous changes," he wrote. "We have met these challenges by embracing new opportunities and expanding into four counties. This has nearly tripled: the number of hospitals in our system, the number of physicians aligned with us, the staff employed at our facilities, and the number of people whose care we actively manage."
"Montefiore is, and will remain, in a league of its own," he added. "We are united in our conviction that the best healthcare is a human right—not a privilege—and I know we will continue to lead the way here and across the nation."
The agency released data showing what it described as the program 'working as intended' to redistribute financial resources according to the relative risk of participating health plans.
After a short-lived stoppage of the Affordable Care Act's permanent risk-adjustment program last year, the Centers for Medicare & Medicaid Services said in a report Friday that the program "operated smoothly for the 2018 benefit year."
By that, the CMS report means the program—which is designed to help stabilize premiums by reallocating financial resources among insurers in accordance with the relative risk levels of the populations they cover—continued to accomplish its objective despite the brief interruption.
"The risk adjustment program is working as intended by more evenly spreading the financial risk carried by issuers that enrolled higher-risk individuals in a particular state market risk pool, thereby protecting issuers against adverse selection and supporting them in offering products that serve all types of consumers," the report states.
A total of 572 insurers participated in the risk-adjustment program last year, down from 654 insurers a year prior. Total transfers for the 2018 benefit year were about $10.4 billion, with half of that amount being payments CMS disbursed and the other half being charges CMS collected, since the program is required by law to be budget neutral.
The program has been controversial among insurers, with smaller health plans and co-ops arguing that the payments are calculated in a way that benefits larger health plans. New Mexico Health Connections, a nonprofit health plan based in Albuquerque, persuaded a federal judge last year to declare the government's methodology illegal. That decision was purportedly the reason CMS froze the program last July, though some critics accused the administration of pouncing on the court decision as a form of "aggressive and needless sabotage" to undermine the ACA's operation. Others argued the panic was overblown. (The litigation is ongoing.)
The payments were unfrozen for the 2017 benefit year two-and-a-half weeks later, and CMS adopted a fix for the 2018 benefit year in December. The relevant policies for the 2019 benefit year weren't subject to the judge's ruling.
The leadership changes announced by UnitedHealth Group affect C-suite posts for both its UnitedHealthcare and Optum divisions.
UnitedHealth Group, based in Minnetonka, Minnesota, announced some changes Friday to its senior executive team, following the retirement of UnitedHealthcare CEO Steve Nelson.
The changes affect C-suite leadership posts for both UnitedHealthcare, which offers health insurance and benefits services, and Optum, which offers information and tech-enabled services.
Dirk C. McMahon, who is currently the president and chief operating officer for Optum, has been named Nelson's successor as UnitedHealthcare CEO.
Daniel J. Schumacher, who is currently president and COO of United Healthcare, has been named McMahon's successor as Optum's president and COO.
McMahon, who joined the company in 2003, has held a number of senior positions, according to the announcement. He ran UnitedHealth Group's enterprise-wide operations and served as CEO of OptumRx.
Schumacher, who joined the company in 1999, has also a number of senior positions across UnitedHealth Group. As part of his new role, he will oversee OptumInsight, the company’s data, analytics, and technology business, as well as Optum Technology and Optum operations.
"We are deeply grateful to Steve Nelson for his 15 years of service—each day over those years Steve brought a sharp focus on our members, the providers who care for them and our colleagues who support them—all with the highest level of integrity. We are a better company as a result of his service, and he is leaving at a time of strength in the business," said UnitedHealth Group CEO David S. Wichmann said in a statement.
The two Midwestern health systems say their union would form a combined system with more than $11 billion in annual operating revenue.
Two nonprofit health systems say they are exploring a possible merger to form one of the 15 largest health systems in the country.
Sanford Health, based in Sioux Falls, South Dakota, and UnityPoint Health, based in Des Moines, Iowa, announced plans Friday to combine their operations together into a single health system with hospitals, clinics, health plans, and more across 26 states.
The combined company would have more than $11 billion in annual operating revenue and employ more than 83,000 staffers and 2,600 physicians, the organizations said. Although the details are still being worked out, the parties intend to close on the deal by the end of this year, pending regulatory reviews.
Sanford Health President and CEO Kelby Krabbenhoft, who is expected to become president and CEO of the post-merger company, said in a statement that Sanford and UnityPoint are already successful but that combining forces will empower them to serve not only individuals but also major health plan sponsors across a broader swath of the country.
"We believe that in the very near future, fully integrated health systems will drive greater value through affordable options for high-quality health care to patients, governments and employers," Krabbenhoft said. "The combination of Sanford and UnityPoint will help both organizations better meet this need, creating a new system positioned for continued growth across a broad geography."
UnityPoint Health President and CEO Kevin Vermeer, who is expected to become senior executive vice president of the post-merger company, said in the statement that the merger will open new doors to value-based care, potentially with more downside risk.
"Working together, we will find new ways to broaden access to care—beyond the traditional settings—and take greater responsibility for the health of the populations we serve," Vermeer said.
In a memo to UnityPoint stakeholders, Vermeer said the merger isn't just about scaling up.
"The opportunity to partner with Sanford represents an opportunity to get bigger, but not for the sake of growth alone," Vermeer said. "If we get bigger in terms of geography, it's so we can do better, on your behalf."
"We are not being sold or acquired—we're intentionally shaping a new path forward, so we can continue to be your partner in health," he added.
If the deal is finalized, the post-merger company would establish a new governing board, with representatives from each of the two organizations, plus unaffiliated board members who have experience and expertise with the national industry, according to the announcement.
The announcement comes a decade after Sanford merged with MeritCare, based in North Dakota, and it comes after Sanford merged last year with the Good Samaritan Society, which provides senior care, as the Sioux Falls Argus Leader's Jonathan Ellis and Tony Leys reported.
Anne Klibanski, MD, who had been the nonprofit's chief academic officer since 2012 before she became interim president and CEO earlier this year, says the organization has room for improvement.
For the first time since its founding a quarter-century ago, Boston-based Partners HealthCare has named a woman to the top executive role, dropping the "interim" from the title Anne Klibanski, MD, picked up earlier this year.
Klibanski stepped into the role on a temporary basis in February after the sudden retirement announcement of her predecessor, David Torchiana, MD. Although board members had initially indicated that they would conduct a national search for Torchiana's replacement, they said Tuesday that all signs have kept pointing them to Klibanski.
"Over the past several months, it has become increasingly clear to each member of the board that Anne is the ideal leader for Partners as we move forward together as a truly integrated system," said Partners board chair Scott Sperling in a statement, complimenting Klibanksi for demonstrating her ability to lead such a large and complex system.
"Her long and extraordinary experience and leadership in research and teaching is so important to a system that is the global leader in life sciences research and the educator of the next generation of doctors and health system leaders," Sperling said. "Her commitment to serving the unmet need of our local communities is crucial. It became obvious to us that any search was going to lead us right back to Anne."
Leaders from both Partners and its two biggest hospitals, Massachusetts General Hospital (MGH) and Brigham and Women's Hospital, have been debating in recent months how the health system should be integrated and who should take the lead, either the corporate office or the hospitals, as The Boston Globe's Priyanka Dayal McCluskey reported.
Torchiana's retirement came amid disagreement over new outpatient clinics and the Partners mergers and acquisitions strategy, as the Globe reported.
Partners had been trying to acquire Care New England (CNE), based in Providence, Rhode Island. Even after Torchiana's retirement, CNE expressed confidence in the deal. Partners backed away from the transaction earlier this month, however, as Rhode Island Gov. Gina M. Raimondo nudged CNE into another round of negotiations with organizations within the state.
Klibanski said at the time that Partners would withdraw its application to acquire CNE but "look forward to reengaging at the appropriate time."
Before taking on the mantle of interim president and CEO, Klibanski had been chief academic officer for Partners since 2012, overseeing research, teaching, and other responsibilities. She also served as the chief of neuroendocrine at MGH and is a professor of medicine at Harvard Medical School.
In a statement, Klibanski said Partners is entering a new stage of collaborative improvement.
"In recent months members from hospital boards across the system have started to work together in a way we have not seen before at Partners," Klibanski said. "I am honored to have the opportunity to realize the full potential we have to transform health care and make it better for patients and families everywhere."
"Partners HealthCare is a great organization," she said, "but I believe we can be even better."
The organization said it is accelerating its plans and upping its investment in Orange County, in response to the market's pressing need.
City of Hope, an independent research and cancer treatment center based in Duarte, California, announced plans more than a year ago to partner with a developer of mixed-use planned communities to build a $200 million cancer treatment facility in Irvine. Those plans just got a whole lot bigger.
The nonprofit announced Tuesday morning that it will accelerate the project's timeline and increase its planned investment to more than $1 billion. The new campus, which will be built on about 11 acres of land at the FivePoint Gateway in Irvine, is expected to include not only an outpatient facility but also a clinical research center, integrated cancer preventive care, and a specialty hospital focused exclusively on treating and curing cancer.
City of Hope President and CEO Robert Stone, JD, says the organization revised its strategy in response to a recognition of the community's growing demand.
"It wasn't until we announced we were coming and did a needs assessment that we saw how great the need was for the highly specialized care we would bring," Stone tells HealthLeaders.
As the population ages in Orange County, the cancer incidence rate is projected to increase 18% over the coming decade, according to City of Hope's market research. At present, nearly one in five cancer patients in the area travel for advanced care. Since it can take Irvine residents two hours to commute across the Los Angeles metro area to City of Hope's main campus in Duarte, opening this second campus is part of the organization's effort to provide care closer to home.
Annette Walker, MHA, president of City of Hope Orange County, said in a statement that the organization's leaders have spent the past year listening to Orange County residents and revising their plans accordingly.
"It became evident that we needed to bring our highly specialized treatments as soon as possible," Walker said. "We're delivering on our promise and opening our doors faster to alleviate the unnecessary hardships on patients and their families."
The plan announced last year had called for a 73,000-square-foot cancer center to be developed on property donated to City of Hope by FivePoint Holdings, LLC. The revised plan, however, calls for City of Hope to purchase about 11 acres and an existing 190,000-square-foot building.
"We believed that we would build from the ground up on vacant land," Stone says. "We now have the opportunity to cut our market entry time in half by taking a building that was already in existence, the shell was already in existence."
Under the plan announced last year, the new facility was slated to open by 2025. Under the updated plan, the facility is slated to open in 2021, with the outpatient facility expected to open first, Stone says.
City of Hope already has 30 clinical care sites across the five-county region, with another facility slated to open this year in Newport Beach. But this bigger investment in Irvine is different, Stone says. Rather than focusing on care delivery alone, the Irvine campus will include major research and innovation-seeking operations.
"This, for us, is in many ways creating a second campus," he says.
The organization has grown significantly in the past five years. City of Hope saw 25,000 patients in 2014; that number more than tripled to 83,000 in 2018, Stone says.
The total price tag of more than $1 billion will be split roughly half-and-half between capital needs and programmatic needs, Stone says, adding that the organization is pleased to associate itself with a broader development that includes residential, commercial, and recreational spaces as well.
"Having the ability to partner with a developer like FivePoint to not just create this cancer campus of the future here in Irvine but also have the potential to be shoulder-to-shoulder in defining what a broader medical community and broader needs are and to embed ourselves in a community is a unique opportunity," he says.
FivePoint Holdings LLC Chairman and CEO Emile Haddad said in the statement that his company believes in building a sustainable society, with places that offer equal access and spaces "where the body, mind and soul get strengthened together."
"Because it takes a village to build a community, FivePoint is constantly searching for partners that innovate and shape the future of how people will live," Haddad says. "As FivePoint considered the importance of wellness, it was clear that City of Hope is the ideal partner to bring world-class cancer treatment and research to Irvine and Orange County."
Officials say the move will result in lower healthcare costs by unleashing competition. Some industry stakeholders are disputing that claim.
President Donald Trump issued a highly anticipated executive order Monday, directing federal agencies to push for greater price transparency among healthcare providers and insurers.
In his typical hyperbolic style, Trump described the order's impact as "the opposite of Obamacare" and said some people say it's even "bigger than healthcare itself."
"With this order, hospitals will be required to publish prices that reflect what people actually pay for services in a way that's clear, straightforward, and accessible for all," Trump said.
"Prices will come down by numbers that you don't even believe," he added.
As has been the case with some of his past healthcare-related announcements, Trump's order is light on details and directs Health and Human Services to fill in the gaps with a more fully fleshed policy and a potentially long rulemaking process.
A fact sheet from the White House says the following items are included in the order:
HHS "will require hospitals to publicly disclose amounts that reflect what people actually pay for services in an easy-to-read format";
HHS "will begin the process of making information on out-of-pocket spending more readily available to patients before they receive care";
"Researchers, innovators, and providers will get more access to data that will help them develop tools to provide patients with more information about healthcare prices and quality";
The administration "will improve quality measurements and make them public"; and
The order expands benefits for tax-preferred health accounts.
During the signing ceremony, Trump yielded the podium briefly to R. Lawrence Van Horn, PhD, MBA, MPH, an associate professor management in economics and the executive director of health affairs at Vanderbilt University, who said the executive order's freemarket approach will reduce costs and benefit the economy overall.
"Lower prices for healthcare leaves more money in Americans' wallets and paychecks for the purchase of all other goods and services that are important for their lives," he said.
Not everyone agrees with that assessment. To the contrary, America's Health Insurance Plans (AHIP) President and CEO Matt Eyles said in a statement that requiring the public disclosure of negotiated rates "will reduce competition and push prices higher" for consumers and taxpayers alike.
"Competition experts, including the bipartisan Federal Trade Commission, agree that disclosing privately negotiated rates will reduce incentives to offer lower rates, creating a floor—not a ceiling—for the prices that hospitals would be willing to accept," Eyles said in the statement released Monday before Trump's announcement.
Rather than supporting the shift to value-based care, compelling the disclosure of negoatiated rates "perpetuates the old days of the American health care system paying for volume over value," Eyles added.
HHS Secretary Alex Azar and Centers for Medicare & Medicaid Services Administrator Seema Verma joined Trump for the signing ceremony and each released statements praising the executive order.
"The President's action today represents one of the major steps in the long history of American healthcare reform, and one of the most significant steps ever taken to put American patients in control of their care," Azar said. "For decades, America's healthcare system has kept price and quality information secret from the patients who need it. Healthcare experts all across the political spectrum have long agreed this has to change."
"The President has promised American patients the affordability they need, the options and control they want, and the quality they deserve, and that's what today's action helps deliver," he added.
Verma said the announcement shows Trump's commitment to ensuring that Americans can know both price and quality information about their healthcare.
"Since day one, this Administration has made great strides in increasing transparency to foster competition in our healthcare system to keep care affordable, and empowering patients to make informed healthcare decisions," she said. "I am excited to implement these bold reforms to transform our healthcare system into one that delivers affordable and accessible healthcare, and puts American patients first."
The justices agreed to hear arguments over whether Congress can pass riders that withhold funds in contravention of the relevant law's intent without actually repealing the relevant law.
The U.S. Supreme Court agreed Monday to take up three consolidated cases from health plans challenging Congress' refusal to authorize $12 billion in risk-mitigation payments under the Affordable Care Act.
The cases—which were brought by Maine Community Health Options, Moda Health Plan Inc., and Land of Lincoln Mutual Health Insurance Co.—argue that the ACA's risk corridor program obligated Health and Human Services to make payments that the law intended "to induce insurer participation in the health insurance exchanges by mitigating some of the uncertainty associated with insuring formerly uninsured customers."
Following the 2014 midterm election, lawmakers on Capitol Hill enacted an appropriations law for fiscal year 2015 that "would potentially allot money to HHS to cover" any such payments for the 2014 benefit year, but the law included a rider that required HHS to maintain the budget neutrality of the risk corridor program, the health plans said in their petition.
Because the amounts collected under the risk corridor program for 2014 "came nowhere close to what the government owed to insurers," the government paid out only 12.6% of the total owed for the year, prorating the funds it owed to each insurer, the health plans wrote.
Similar riders were included in appropriations bills for fiscal years 2016 and 2017. But HHS used the funds it collected from benefit years 2015 and 2016 to further pay what it owed from the 2014 benefit year, making no payments for the 2015 and 2016 benefit years, the health plans wrote. (The program ended after three years.)
The health plans proposed two questions in the petition for a writ of certiorari for the justices to consider, but the justices agreed to hear argument only on the first: "Given the 'cardinal rule' disfavoring implied repeals—which applies with 'especial force' to appropriations acts and requires that repeal not be found unless the later enactment is 'irreconcilable' with the former—can an appropriations rider whose text bars the agency's use of certain funds to pay a statutory obligation, but does not repeal or amend the statutory obligation, and is thus not inconsistent with it, nonetheless be held to impliedly repeal the obligation by elevating the perceived 'intent' of the rider (drawn from unilluminating legislative history) above its text, and the text of the underlying statute?"
In its response to the health plans' petition, the U.S. government argued that a Government Accountability Office report identified only two possible sources of funding for the risk corridor payments: (1) the funds collected by HHS under the program itself, and (2) any lump-sum appropriation to manage certain Centers for Medicare & Medicaid Services programs. By enacting the appropriations laws as it did, Congress said that only the first funding source would be allowed, the response states.
America's Health Insurance Plans (AHIP) President and CEO Matt Eyles said in a statement that insurers need stability from the government.
"Millions of Americans rely on the individual and small group markets for their coverage and care. Health insurance providers are committed to serving these patients and consumers, working with the federal government to deliver affordable coverage and access to quality care," Eyles said. "The Supreme Court's decision to hear this case recognizes how important it is for American businesses, including health insurance providers, to be able to rely on the federal government as a fair and reliable partner. Strong, stable and predictable partnerships between the private and the public sector are an essential part of our nation's economy, and our industry looks forward to having this matter heard before the Court."
The justices allotted one hour for oral argument on the dispute.
Editor's note: This story was updated Monday afternoon to include AHIP's statement.
The president plans to direct federal agencies to begin the regulatory work of requiring healthcare providers and insurers to disclose information about their negotiated rates.
President Donald Trump's big move on healthcare price transparency is expected to come next week.
Trump plans to issue an executive order Monday to direct federal agencies to begin the regulatory process of forcing providers, insurers, and others to disclose more information about their negotiated rates and discounts, as The Wall Street Journal's Stephanie Armour reported Thursday evening, citing unnamed sources.
Armour reported last month that the Trump administration is likely to use the Outpatient Prospective Payment System (OPPS) rule this summer to require hospitals to disclose their negotiated rates. That could be a very big deal for the industry. But it's not clear how far the executive order will go, in light of firm pushback from powerful industry groups.
Despite the industry's pushback, Trump may have a strong political incentive to proceed with gusto. An overwhelming majority of voters, 88%, say they would favor a government initiative to require insurers, hospitals, doctors, and other providers to disclose costs, discounts, and negotiated rates, according to polling conducted last month by the Harvard Center for American Political Studies and the Harris Poll.
Trump ceremonially launched his 2020 reelection campaign this week, as he and fellow Republicans look for ways to resonate with voters on their healthcare priorities—even as the administration has sent mixed messages on whether it will pursue a legislative replacement for the Affordable Care Act before next year's general election.
In an interview with ABC News that aired last Sunday, Trump said "we already have the concept of the plan" to replace the ACA. Republicans will implement that plan if they win back control of the U.S. House of Representatives and retain both the U.S. Senate and the presidency in 2020, he said, noting that the plan itself will be announced within two months. "We'll be having a plan much before the election," he said. "Soon. Fairly soon."
Trump said the Republican plan will address the big reasons why people hate the Obama-era law.
"It's too expensive, it's not good," he said, "but if we win the House, we win the Senate, we win the presidency. You're going have the greatest healthcare that anybody's ever had."
Trump's planned executive order and his rhetoric on a legislative ACA replacement come as a bipartisan group of senators push a healthcare bill of their own, with a variety of price transparency components.